(a)The following words and terms, when used in this
section, have the following meanings.
(1)COVID-19 therapeutic leave--Leave described in
a state plan amendment approved by the Centers for Medicare and Medicaid
Services for payment to providers for reserving a bed in a facility
for an individual who takes a temporary leave of absence to reduce
the risk of COVID-19 transmission.
(2)Extended therapeutic leave--Leave described in §261.226(c)
of this chapter (relating to Leaves).
(3)Facility--An intermediate care facility for individuals
with an intellectual disability or related conditions.
(4)Full day--A 24-hour period extending from midnight
to midnight.
(5)HHSC--The Texas Health and Human Services Commission.
(6)Individual--A person enrolled in the ICF/IID Program.
(7)Program provider--An entity with whom HHSC has
a provider agreement.
(8)Provider agreement--A written agreement between
HHSC and a program provider that obligates the program provider to
deliver ICF/IID Program services.
(9)Revenue--This term does not include a loan or grant
that a program provider is required to repay.
(10)Special leave--Leave described in §261.226(d)
of this chapter.
(11)Staff member--An employee or contractor of a program
provider.
(12)Therapeutic leave--Leave described in §261.266(b)
of this chapter.
(b)If an individual is absent from a facility for
one full day and such absence is not during a therapeutic, extended
therapeutic, COVID-19 therapeutic, or special leave, the program provider
must discharge the individual from the facility.
(c)COVID-19 therapeutic leave is in addition to the
days allowed for therapeutic leave or extended therapeutic leave.
(d)If an individual takes COVID-19 therapeutic leave,
the program provider must ensure that the individual's individual
program plan specifies that the individual was absent from the facility
to reduce the risk of COVID-19 transmission.
(e)A program provider must submit an HHSC bed hold
payment attestation form, as described in subsection (f) of this section,
and a request for payment for COVID-19 therapeutic leave to HHSC on
or before April 30, 2021.
(f)For a program provider to receive payment for COVID-19
therapeutic leave, the program provider must submit a completed HHSC
bed hold payment attestation form on or before the date the program
provider requests payment for COVID-19 therapeutic leave. By signing
an HHSC bed hold payment attestation form, a program provider:
(1)acknowledges that HHSC may recoup an overpayment
made to the program provider if:
(A)HHSC determines, based on a federal or state audit
or any other authorized third-party review, that the program provider:
(i)received an inappropriate payment, such as payment
for more days than allowed for COVID-19 therapeutic leave;
(ii)received duplicate payments for services, such
as payment for COVID-19 therapeutic leave for a day on which HHSC
paid the program provider for therapeutic, extended therapeutic, or
special leave; or
(iii)received funding from any other source to pay
for the days of COVID-19 therapeutic leave for which payment is requested;
and
(B)the program provider's revenue for the quarters
described in the state plan amendment exceeded its revenue:
(i)during the quarter of December 2019 through February
2020; or
(ii)an alternative pre-pandemic period authorized
in writing by HHSC based on a request from the program provider; and
(2)attests that, during the time period for which
payment is requested, the program provider:
(A)did not lay off any staff members who were working
on March 19, 2020, due to lack of work, not work performance; and
(B)maintained staff member wages and benefits at least
at the levels that existed on March 19, 2020.
(g)When submitting a request for payment, a program
provider must use the designated leave code that identifies the request
as payment for COVID-19 therapeutic leave.
(h)If HHSC determines, based on a federal, state,
or third-party review or audit, that a program provider is not in
compliance with this section or the program provider makes an attestation
described in subsection (f)(2) of this section that is inaccurate,
HHSC recoups payment made for COVID-19 therapeutic leave from the
program provider.
(i)An HHSC bed hold payment attestation form covers
payments for COVID-19 therapeutic leave requested only for the dates
identified on the form. A program provider must submit a separate
form for each provider agreement that the program provider has with
HHSC.
The agency certifies that legal counsel has reviewed
the emergency adoption and found it to be within the state agency's
legal authority to
adopt.
Filed with the Office
of the Secretary of State on January 29, 2021
TRD-202100412 Karen Ray
Chief Counsel
Health and Human Services Commission
Effective date: January 29, 2021
Expiration date: May 28, 2021
For further information, please call: (512) 438-4287
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